Conceptualising Long COVID as an episodic health condition

An estimated 6.2% of the U K population self-identified experiencing Long COVID, which negatively affected their general well-being and ability to exercise and work.1 Long COVID symptoms also adversely affected day-to-day activities among 64.7% of those self-reporting Long COVID, with 19.3% reporting significant limitations to daily activities.2 The long-term trajectory of Long COVID remains unknown. [...]conceptualising disability in Long COVID is essential for better understanding the lived experiences and health-related challenges of people living with and affected by Long COVID, to inform effective rehabilitation approaches and interventions to enhance clinical practice, policy and research. Stigma related to disbelief of symptoms and the complexity of diagnostic uncertainty, particularly among those without a COVID-19 PCR, antigen or antibody test, can add complexity to those faced with challenges accessing employment or income benefits after leaving the workforce during illness, further contributing to disability and reduced quality of life after acute COVID-19.9 Uncertainty and worrying about the future is an important feature of living with Long COVID. Episodic Disability Framework The Episodic Disability Framework was derived from the perspectives of people living with HIV in Canada to characterise the multidimensional and sometimes fluctuating nature of health challenges.7 The Episodic Disability Framework includes: (1) dimensions of disability (physical, cognitive, mental and emotional health, daily activities, social inclusion and uncertainty); (2) contextual factors, which include extrinsic (eg, support, environment and stigma) and intrinsic (self-care living strategies and personal attributes) factors that influence disability and (3) triggers, which can exacerbate a momentous episode.7 Empirically validated with adults living with HIV, the Episodic Disability Framework provides a novel method for conceptualising the multidimensional nature of living with chronic illness by capturing experiences of uncertainty and the temporal (fluctuating) feature of disability over time.12 We argue that this Framework may be an ideal approach from which to conceptualise disability experienced by people living with Long COVID. Using a disability inclusive approach with standardised patient reported outcome measures (PROMs) designed to capture the nature and extent of disability and its fluctuation over time is critical to guide the provision of care, determi